肝硬化食管静脉曲张程度与消化性溃疡的相关性分析

目的 探讨肝炎后肝硬化食管静脉曲张程度与消化性溃疡的相关性。方法 以北京地坛医院1998年1月-2000年12月收治并经电子胃镜检查的肝炎后肝硬化1035例患者为研究对象。结果 1035例患者中，男845例，女179例。无静脉曲张：66例，其中合并消化性溃疡15例(22．7％)；门脉高压性胃病3例(4．6％)。轻度静脉曲张485例，合并消化性溃疡131例(27．0％)；门脉高压性胃病61例(12．6％)，中度静脉曲张203例，合并消化性溃疡74例(36．5％)；门脉高压性胃病63例(31．0％)。重度静脉曲张281例，合并消化性溃疡97例(34．5％)；门脉高压性胃病94例(33．5％)；消化性溃疡和门脉高压性胃病的总检出率分别为：317／1035(30．6％)、221／1035(21．4％)。结论 消化性溃疡和门脉高压性胃病的检出率随食管静脉曲张程度的加重而明显增加。     

肝硬化并上消化道出血52例临床分析

目的 探讨肝硬化合并上消化道出血患者的出血原因,指导治疗。方法 对52例肝硬化合并上消化道出血生命体征平稳的患者（即血压、脉搏在正常范围内,神志清楚）行急诊胃镜检查及Child-pugh分级。结果 （1）52例肝硬化合并上消化道出血的原因：食管胃底静脉曲张破裂出血（静脉曲张破裂出血）占51.92%,非静脉曲张破裂出血占48.08%,两者比较,差异无显著性（P〉0.05）。在Child-poughA级中,静脉曲张破裂出血占23.08%,非静脉曲张破裂出血占5.77%,两者比较,差异有显著性（P〈0.05）,在Child-pough C级中,非静脉曲张破裂出血占25.00%,静脉曲张破裂出血占11.53%,两者比较,差异有显著性（P〈0.05）;（2）非静脉曲张破裂出血原因包括消化性溃疡和门静高压性胃病,在Child-poughC级中,门脉高压性胃病出血占17.13%,消化性溃疡出血占7.69%,两者比较,差异有显著性（P〈0.05）。结论 肝硬化合并上消化道出血的病因中,除了食管胃底静脉曲张破裂出血的原因外,门脉高压性胃病及消化性溃疡也是其重要的原因,尤其在肝功能分级在Child-pough C级的患者中非静脉曲张破裂出血较多,治疗时更应引起注意和重视。     

肝硬化并发上消化道出血的相关因素分析

目的对肝硬化并上消化道出血患者的食管静脉曲张程度、胃黏膜病损程度进行相关性分析。方法肝硬化并上消化道出血患者行急诊胃镜检查,食管静脉曲张根据其内镜表现分无、轻、中、重度;门脉高压性胃病（PHG）按McCormack内镜诊断标准分类。结果200例上消化道出血患者中,食管胃底静脉曲张破裂出血（GEVB）100例（50．0％）;PHG出血44例（22．2％）;消化性溃疡出血38例（19．0％）;其他原因出血18例（9．0％）;发生率在肝功能B级、C级组与肝功能A级组比较（其他原因组除外）差异有统计学意义（χ^2=4．23,χ^24．15,χ^2=4．18,χ^2=4．07,P〈0．05;0=6．83,χ^2=7．01,P〈0．01）;门静脉直径〉1．5cm破裂出血发生率（32．5％）明显高于直径〈1．1cm（12．5％）（χ^2=4．73,P〈0．05）;重度食管静脉曲张发生PHG程度（55．6％）高于轻度食管静脉曲张（11．1％）（χ^2=7．73,P〈0．01）,PHG的轻重程度与食管静脉曲张程度呈正相关（r=0．455,χ^2=4．01,P〈0．05）。结论食管静脉曲张破裂出血与门脉高压性胃病出血是引起肝硬化并上消化道出血的主要原因。     

肝硬化合并上消化道出血的临床分析

目的 探讨肝硬化合并上消化道出血的发病原因,为临床诊疗提供必要的指导.方法 选择2011年7月-2012年8月我院收治的肝硬化合并上消化道出血的患者52例,通过对其进行胃镜检查以及Child-pugh分级,并安排专人对所得数据进行及时的登记与分析.结果 引发患者上消化道出血的因素中,静脉曲张破裂出血占50%,非静脉曲张破裂导致患者出血占50%;两者比较差异无统计学意义（P＞0.05）.导致患者非静脉曲张破裂出血因素可以分为消化性溃疡出血以及门脉高压性胃病出血两大原因,且Child-pugh C级的门脉高压性胃病出血的概率高于消化性溃疡出血,差异有统计学意义（P＜0.05）.结论 引发患者出现肝硬化合并上消化道出血的原因,不仅有食管胃底静脉曲张破裂出血,还与消化道溃疡以及门静脉高压性胃病有关,特别是在Child-pugh C级中,非静脉曲张破裂出血的情况相对较多,广大医师在临床治疗中应该对其高度重视.     

肝硬化上消化道出血的治疗

没有精确的大样本临床统计，肝硬化上消化道出血的常见原因主要是食管-胃底静脉曲张破裂和酸相关性疾病（消化性溃疡或急性出血糜烂性胃炎）。静脉曲张破裂出血可因粗糙食物、化学性刺激及腹内压增高等因素而引起，其发生率大约30％左右；酸相关性疾病的发生率大约50％左右，其原因或诱因与消化性溃疡相同。余下的病因可能是门脉高压性胃病，极少见的病因包括贲门粘膜撕裂综合征和胃癌等。     

肝硬化伴消化性溃疡 87例临床分析

门脉高压引起急性上消化道大出血的原因除了有食管胃底静脉曲张破裂出血、门脉高压性胃病以外，还包括消化性溃疡（PU）、息肉、肿瘤等疾病。据报道犤１犦，PU伴出血占门脉高压大出血的６．５％。下面对１９９５～２００１年我院收治的６１２例肝硬化伴PU８７例（１４．２％）进行临床分析。临床资料１．诊断标准本组６１２例患者经病史、临床症状及B超、血肝功能等辅助检查确诊为肝硬化；全部行内镜检查，诊断肝硬化前否认PU病史。２．临床资料８７例中男性７１例，女性１６例，年龄３２～７５岁，平均５７．３岁。８７例肝硬化伴PU患…     

73例肝硬化合并上消化道出血的诊治分析

目的探讨肝硬化合并上消化道出血患者的临床特点和诊治方法。方法回顾性分析73例肝硬化合并上消化道出血患者的出血原因、诱因和治疗方法。结果50例为食道胃底静脉曲张破裂出血（68．5％），13例为门脉高压性胃病出血（17．8％），10例为消化性溃疡出血（13．7％）。出血诱因包括饮酒17例（23．3％），药物（非甾体类为主）20例（27．4％），过度劳累14例（19．2％），精神刺激14例（19．2％），原因不明8例（10．9％）。出血与肝功分级、并发症有相关性（P〈0．01），与病因无相关性。经综合治疗，2周内无活动性出血65例，总有效率为89．0％。结论对于肝硬化合并上消化道出血患者应掌握临床特点、及早查明出血原因并进行相应治疗。     

胃镜检查肝硬化合并上消化道出血的临床研究

目的对肝硬化合并上消化道出血患者做胃镜检查,观察食管静脉曲张程度、门脉高压性胃病（PHG）情况、胃黏膜病变程度,探讨导致上消化道出血的其他病因,并对食管静脉曲张程度与胃黏膜病损程度进行相关性分析。方法对肝硬化合并上消化道出血患者进行急诊胃镜检查,观察食管静脉曲张程度,根据其内镜表现分为无、轻、中、重度4级;门脉高压性胃病（PHG）按Comgack内镜诊断标准分3类[1]。结果120例上消化道出血患者,食管静脉曲张破裂出血98例占82.7%（98/120）;PHG出血54例占45%（54/120）;非食管静脉曲张和非PHG22例,占出血总数的18.3%（22/120）,其中急性胃黏膜病变出血10例（0.8%）,消化性溃疡出血8例（0.6%）,其他不明原因出血4例（0.3%）;食管静脉曲张程度与PHG病变呈明显正相关（P〈0.01）。结论食管静脉曲张破裂出血与PHG出血是引起肝硬化合并上消化道大出血的主要原因;随着食管静脉曲张程度的加重,PHG逐渐增多和加重,食管静脉曲张破裂出血与PHG可同时并存;急性胃黏膜病变与消化性溃疡等也是导致肝硬化上消化道大出血的常见原因。     

门脉高压性胃病临床治疗分析

目的探讨门脉高压性胃病（PHG）与食管静脉曲张、幽门螺杆菌（Hp）感染的关系。方法本文对127例肝硬化门脉高压患者胃镜检查资料分析。结果PHG发生率59．84％（76／127），其中发生在胃底占50％（38／76），Hp感染的阳性率为64．47％（49／76），PHG轻度程度与食管静脉曲张程度有关系（P〈0．05）。结论PHG好发于胃底，其发生率及轻重程度与食管静脉曲张程度呈正相关，与Hp感染密切相关。     

肝硬化45例胃镜结果分析

目的提高对肝硬化门脉高压性胃病的认识。方法分析45例肝硬化病例的胃镜检查结果。结果45例肝硬化胃镜检查表现主要是食道静脉曲张和门脉高压性胃病(PHG)。结论肝硬化胃镜表现主要是食道静脉曲张、PHG,PHG也是肝硬化并上消化道出血的重要原因。     

Factors predisposing to peptic ulcer disease in asymptomatic cirrhotic patients

BACKGROUND: There is a high prevalence of peptic ulcer in cirrhotic patients, but the pathogenesis of peptic ulcer in cirrhosis remains inconclusive. AIM: To investigate factors associated with peptic ulcer and to evaluate peptic ulcer prevalence in asymptomatic cirrhotic patients. METHODS: A total of 130 cirrhotics were recruited into the study for endoscopic screening. Data were collected and biochemical tests were done. Doppler ultrasound was used to assess the portal vein velocity and size. Patients underwent endoscopy for the presence of varices and peptic ulcer. Helicobacter pylori infection was confirmed by urease test, histology and 14C-urea breath test. Statistical analysis was performed. RESULTS: Peptic ulcer was detected in 50 (39%) cases. Between peptic ulcer and non-peptic ulcer groups, there were no significant differences in age, sex, alcoholic drinking, smoking, non-steroidal anti-inflammatory drug use, portal vein velocity and size, except for H. pylori infection (P = 0.006), serum albumin (P = 0.02) and Child-Pugh score (P = 0.03). By multivariate analysis, H. pylori infection (OR: 3.26; 95% CI: 1.49-7.13; P = 0.003), Child-Pugh classes B (OR: 2.48; 95% CI: 1.04-5.91; P = 0.04) and C (OR: 3.26; 95% CI: 1.2-8.81; P = 0.02) were independently associated with peptic ulcer. CONCLUSION: H. pylori infection and advanced cirrhosis are important factors associated with active peptic ulcer.     

Surgical management of bleeding esopageal varices: the Tikur Anbessa hospital experience

Surgery is one of the modalities of treatment of portal hypertension with bleeding esophageal varices. Between 1992 and 2003, a total of 33 patients with esophageal varices secondary to hepatic or pre-hepatic causes of portal hypertension underwent proto-azygeal disconnection surgery at Tikur Anbessa Hospital, Addis Ababa University. Twenty-five, (69. 7%) were men and 8 (24.3%) were women. Their age ranged between 13 and 54 years with a mean age of 24.3 years. Eighty two percent of the patients had hematemesis and melena. Thirty-two, (97%) patients had splenomegaly and of these; 27 (84%) had splenomegaqly with hyperslenism. Twenty-one, (63.6%) and 12 (36.6%) patients had child's A and B functional class, respectively. None of the patients was in class C. The condition of the liver as assessed macroscopically at surgery showed portal fibrosis in 22 (66.7%), cirrhosis in 3 (9.1%) and normal liver in 8 (24.2%) patients. There was no significant correlation between variceal bleeding episode and type of liver pathology. Four patients (12%) died after surgery and re-bleeding occurred in one (3%) patients. Porto-azygeal disconnection surgery can be done safely in patients with esophageal varices and good liver function in order to prevent further bleeding episode.     

Splenomegaly as risk factor of liver cirrhosis. A retrospective cohort study of 2,525 patients who underwent laparoscopy

The aim of this study was to evaluate the meaning of laparoscopic splenomegaly and its relationship with the severity and evolution of liver cirrhosis. Medical records of 2,525 consecutive patients with chronic liver diseases who underwent laparoscopy and video-guided hepatic biopsy were reviewed. There were 1,610 (63.8%) men and 915 (36.2%) women. All patients underwent gastroscopy to diagnose esophageal varices. The diagnosis of cirrhosis was made in 910 (36.0%) patients, while 620 (24.6%) had hepatic fibrosis, and 995 (39.4%) chronic active hepatitis. Splenomegaly was present in 460 out of 910 patients (50.5%) with cirrhosis. Among the 1,615 patients without cirrhosis, splenomegaly was present in 80 (4.9%), and esophageal varices were present in 70 out of 910 (7.6%) cirrhotic patients. In patients without cirrhosis, esophageal varices were present in 30 out of 1,615 (1.2%) at the time of laparoscopy. Statistical analysis showed significant differences between patients with cirrhosis and without cirrhosis for splenomegaly (χ(2)=717.03, p<0.001) and esophageal varices (χ(2)=50.57, p<0.001). In conclusion, laparoscopic splenomegaly seems to be an important prognostic factor in liver cirrhosis, which represents a risk factor for portal hypertension.     

肝硬化合并胃底食管静脉曲张患者术后并发症的危险因素分析

目的探讨肝硬化合并胃底食管静脉曲张患者术后并发症的危险因素。方法回顾性分析2012年1月～2013年1月本院收治的肝硬化合并胃底食管静脉曲张出血100例患者与肝硬化合并胃底食管静脉曲张未出血100例患者的临床资料,分析诱发并发症的危险因素。结果两组患者的凝血酶原时间、门静脉主干内径、食管静脉曲张程度、红色征等比较,差异有统计学意义（P〈0．05）。结论肝硬化合并胃底食管静脉曲张患者术后并发症的危险因素主要涉及凝血酶原时间、门静脉主干内径、食管静脉曲张程度、红色征等。     

16 排螺旋 CT 血管成像对肝硬化门静脉系统及侧支循环的诊断价值

目的探讨16排螺旋CT血管成像（MSCTA）在显示肝硬化门静脉系统及侧支循环血管方面的应用价值。方法52例肝硬化患者及30例肝脏正常者行腹部增强扫描,然后行门静脉血管成像检查。分别测量门静脉系统短径,并对其进行统计学分析。结果MSCTA显示肝硬化组食管下段静脉曲张21例次,胃底静脉曲张18例次,胃左静脉曲张23例次,胃短、胃后静脉曲张16例次,附脐静脉开放伴腹壁浅静脉曲张7例次,胃-肾／脾-肾分流5例次,奇静脉及半奇静脉扩张7例次,腹膜后静脉曲张4例次。肝脏正常组脾静脉、门静脉、肠系膜上静脉直径均明显小于肝硬化组（P〈0．05）。结论16排螺旋CT肝脏血管成像在显示肝硬化门脉系统形态变化及门脉高压侧支循环方面具有重要的临床应用价值。     

断流术后再出血原因分析(附20例分析)

目的 探讨断流术后再出血的原因。方法 回顾性分析20例断流术后再出血的临床资料。结果 20例断流术后再出血中由食管静脉曲张所致出血5例，门静脉高压性胃病所致出血15例，其中包括门静脉高压性胃黏膜病交10例，肝源性消化性溃疡5例。结论 断流术后再出血的主要病因是门静脉高压性胃病，其次是食管静脉曲张。断流术后再出血患者应争取急诊内镜检查，明确出血原因。     

Pharmacokinetics of omeprazole in patients with liver cirrhosis and extrahepatic portal venous obstruction

Omeprazole is frequently used in patients with cirrhosis of the liver to treat peptic ulcer disease. It is also used for the healing of mucosal lesions after endoscopic sclerotherapy of esophageal varices in cirrhosis and extraheptic portal vein obstruction (EHPVO). This study was carried out with the aim of determining the pharmacokinetics of omeprazole in different degrees of liver cirrhosis and in patients with EHPVO, compared with healthy volunteers. Ten healthy volunteers, 30 patients with cirrhosis of the liver, divided into 3 groups of 10 depending on severity (according to Child-Pugh classification A, B and C) and ten patients with EHPVO participated in the study. The subjects received an omeprazole 20 mg capsule after an overnight fast. Blood samples were collected at 0, 0.5, 1, 1.5, 2, 2.5, 3, 6, 9 and 24 h after drug administration. Omeprazole level in plasma was estimated by reverse-phase high performance liquid chromatography (HPLC). The elimination half-life was significantly (p < 0.05) increased to 2.38 +/- 0.16, 3.26 +/- 0,12, 3.58 +/- 0.31 and 2.59 +/- 0.22 h in patients with different grades of cirrhosis (A, B and C) and also in patients with EHPVO, respectively, compared with 1.054 + 0.10 h in healthy volunteers. A similar significant increase (p < 0.05) was observed in the AUC(0alpha), while C(max) was significantly increased to 400.40 +/- 27.89 and 602 +/- 55.13 ng/ml in only grade C cirrhosis patients and EHPVO patients, compared with 303.5 +/- 36.42 ng/ml in healthy volunteers. No significant difference was observed in T(max). It was concluded that the metabolism of omeprazole was significantly impaired in both liver cirrhosis and EHPVO in comparison with healthy volunteers.     

肝硬化食管静脉曲张破裂出血患者善宁治疗前、后血清血管紧张素转换酶水平的变化

目的探讨肝硬化食管静脉曲张破裂出血患者善宁应用与血清血管紧张素转换酶（ACE）水平变化的关系。方法采用紫外光度比色分析法测定40例肝硬化食管静脉曲张破裂出血患者善宁治疗前、后及20例健康对照者血清ACE浓度。结果肝硬化食管静脉曲张破裂出血患者善宁治疗前、后血清ACE浓度均明显高于对照组。食管静脉曲张破裂出血患者善宁治疗前血清ACE浓度明显高于治疗72小时后的水平。结论善宁治疗可使肝硬化食管静脉曲张破裂出血患者血清ACE水平下降,这可能与善宁降低门静脉压力的机制有关。     

经皮肝穿刺胃冠状及胃短静脉栓塞术治疗胃底静脉曲张出血

目的探讨经皮肝穿胃冠状静脉、胃短静脉栓塞术对胃底静脉曲张长期疗效。方法 67例肝硬化并胃底重度静脉曲张出血的患者,经皮经肝穿刺行胃冠状静脉、胃短静脉栓塞治疗。栓塞剂主要为无水乙醇、钢圈和明胶海绵。均行1次栓塞治疗,并经48～69个月随访,平均60.2个月,胃镜复查。结果随访期间43例(76.8%)胃底曲张静脉完全消失,8例(14.3%)胃底静脉曲张复发、无红色征及糜烂,有3例(5.4%)胃底静脉曲张破裂出血,食管静脉曲张程度无明显变化,而1例(1.8%)因门脉高压性胃炎致黏膜糜烂出血,未发现明显并发症。结论经皮肝穿刺行胃冠状静脉、胃短静脉栓塞治疗具有胃底静脉曲张消失率高,复发率低,长期疗效好。